Abstract
BackgroundPatients with type 2 diabetes mellitus (DM) display a predisposition for vascular disease. Platelets taken from vasculopathic diabetic patients, show enhanced stimuli-induced activation and aggregation responses. Aspirin remains the cornerstone antiplatelet agent for secondary prevention of vascular complications among diabetic patients, yet evidence of its efficacy and safety in primary prevention are conflicting. Our aim was to assess whether high risk diabetic patients, without previous ischemic events, have abnormal platelet functionality profiles.MethodsThe study included 82 diabetic patients and 86 matched non-diabetic patients without prior ischemic events nor treatment with anti-platelet medications. Blood samples were analyzed for platelet markers of activation, turnover and leukocyte-platelet interactions.ResultsOur final analysis included 122 males (74 %), with a mean age of 61 years. Mean platelet volume (MPV) was similar between the diabetic patients and controls (9.2 fL for both). Following activation, PAC-1 binding and P-selectin expression were found comparable between the diabetic patients and controls (83 % versus 81 % and 76 % versus 74 %, respectively). Leukocyte-platelet aggregates (LPAs) were similar between the diabetic patients and controls (18 % versus 17 %, respectively). Neutrophil-platelet aggregates (NPAs) and monocyte-platelet aggregates (MPAs) were also found similar in the diabetic patients and controls. Elevated fasting plasma glucose was associated with increased LPAs rates.ConclusionsHigh risk type-2 diabetes mellitus patients, without prior ischemic events, have normal blood platelet functionality profiles.
Highlights
Patients with type 2 diabetes mellitus (DM) display a predisposition for vascular disease
Diabetic patients present with persistent thromboxanedependent platelet activation, with aspirin playing a pivotal role in the prevention of vascular complications in DM [19]
The American Diabetes Association (ADA) published guidelines stating that prophylactic aspirin therapy appears to have a modest effect on ischemic vascular events with an absolute decrease in events, depending on the underlying CV risk [30]
Summary
Patients with type 2 diabetes mellitus (DM) display a predisposition for vascular disease. Aspirin remains the cornerstone antiplatelet agent for secondary prevention of vascular complications among diabetic patients, yet evidence of its efficacy and safety in primary prevention are conflicting. Blood platelets play a pivotal role in the blood clotting process by mediating the primary phase of hemostasis Their involvement in atherogenesis and thrombotic complications has been previously well. Diabetic patients present with persistent thromboxanedependent platelet activation, with aspirin playing a pivotal role in the prevention of vascular complications in DM [19]. In order to resolve discrepancies among the results obtained in different clinical trials, several meta-analyses were conducted These studies demonstrated that primary prevention with aspirin generates only a modest beneficiary effect on CV risk reduction [25,26,27,28,29]. The American Diabetes Association (ADA) published guidelines stating that prophylactic aspirin therapy appears to have a modest effect on ischemic vascular events with an absolute decrease in events, depending on the underlying CV risk [30]
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